The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes pain disorders as a somatoform disorder because the symptoms are physical but not entirely understood as a consequence of a general medical condition. The main clinical feature is that pain cannot be fully attributed to a known medical disorder in at least one anatomic site. Pain disorder also is classified as a mental disorder due to psychological factors that influence onset, severity, worsening, or maintenance of pain. Regardless of the unknown cause of pain, it is not intentionally produced and not under the patient’s voluntary control. In pain disorders, the severity, duration, or degree of pain is unable to be identified when observing medical or psychological problems.
Common Pain Disorders
Complex Regional Pain Syndrome (CRPS), also called reflex sympathetic dystrophy syndrome, is a chronic pain condition characterized by severe pain, swelling and changes in the skin. The symptoms are unknown, but experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous system. Those between the ages of 20-35 are most commonly affected, with women affected more often than men.
Myofascial Pain Syndrome (MPS) is a condition characterized by chronic and perhaps severe pain. Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group. This differs from muscle pain that one can normally experience for those suffering from myofascial pain syndrome experience persistent and worsening muscle pain. Treatment options include physical therapy, trigger point injections or medications.
Pain Disorder Theories
A number of theories have been proposed regarding the causes of pain disorders. Adoption studies have found somatization disorders to be five to ten times more common in relatives with this disorder than the general population. Stress may induce dysfunction by releasing corticiptropin-realsing hormone, acetylcholine release, or both. The psychodynamic theory claims that an unconscious conflict, wish, or need is converted into a somatic symptom in hopes to inhibit conscious awareness. Physical abuse, psychological abuse, or both has been shown to be associated with somatization.
The learning theory claims that pain disorder is a learned behavior, that children learn this from role models within the family. The emotions and communication theory claims that a limited vocabulary may lead a child to express distress in terms of physical symptoms. Environmental and social influences theory proposes that in families and cultures that stigmatize psychological problems, individuals may communicate distress through a somatic symptom. The family systems theory, developed my Minuchin, states that families of somatizing children use the following four distinct transactional patterns: enmeshment, over protection, rigidity, and lack of conflict resolution.
Pain Disorder Treatment
Treatment for pain disorders incorporates both physical and psychological elements. Effective mental health treatment groups should include understanding pain as a product of the interaction of physical and psychological factors; learning strategies that produce some control over symptoms or reactions to pain; dealing successfully with anxiety generated by pain; decreasing disability caused by pain; and limiting medical testing that is not helpful or necessary. Types of treatment include counseling, relaxation training, behavioral methods, biofeedback, and family therapy.